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The Drug Czar: Harm Reductionists, Treatment and Recovery Advocates Come Down on Different Sides of Rumored Ramstad Nomination

Former Minnesota congressman, self-acknowledged recovered alcoholic, and treatment and recovery advocate Jim Ramstad is widely rumored to be in the running for head of the Office of National Drug Control Policy (ONDCP -- the drug czar's office), and he is garnering both support and opposition from within the drug reform community, broadly defined.
Jim Ramstad
It may all be for naught. Ramstad himself has asked the Obama transition team to consider him to head SAMHSA, the Substance Abuse and Mental Health Services Administration, a post where his appointment would arguably be less controversial. And President Bush's last-minute appointment Monday of current acting ONDCP deputy director Patrick Ward to replace outgoing drug czar John Walters only muddies the waters further.

While Ramstad has serious credentials on treatment and recovery, his opposition to needle exchange programs spurred drug policy analyst and author Maia Szalavitz to oppose his nomination in an article in the Huffington Post. "Ramstad may be a drug warrior in recovering person's clothing," she wrote, noting that he also opposes medical marijuana.

"While Ramstad has opposed some interdiction efforts and called for more treatment funding, someone who doesn't even believe that addicts have a right to life if they aren't in treatment is not the kind of recovering person that I want representing me as drug czar," Szalavitz, a former injection drug user herself, continued. "That's not change, President Obama -- that's more of the same. Don't make the mistake that Bill Clinton did and install a drug czar who will ignore science and push dogma. While it's great to have a recovering person as an example, just having a disease and talking with others who've recovered the same way you did does not make you an expert. We need someone who knows the science, recognizes that there are many paths to recovery -- and understands that dead addicts can't recover."

Szalavitz wasn't the only alarmed harm reductionist. Psychologist Andrew Tatarsky authored an open letter signed by more than 450 substance use and mental health treatment professionals warning that both SAMHSA and the drug czar's office need leadership that "supports evidence-based policies and that will make decisions based on science, not politics or ideology" and "we have reason to believe that Congressman Ramstad is not that person." In addition to Ramstad's opposition to harm reduction measures, Tatarsky noted that throughout his congressional tenure, Ramstad had failed to take any action on sentencing reform.

A Ramstad nomination also drew concern from the National Organization for the Reform of Marijuana Laws (NORML), which noted in a blog post that Ramstad had voted against medical marijuana at every opportunity, voted against needle exchange, and had been appointed to the board of directors of Joe Califano's anti-drug reform propaganda organization, the National Center for Addiction and Substance Abuse (CASA).

But while drug reformers and advocates of science-based policies raised concerns, parts of the treatment community are supporting Ramstad. In a January 11 letter to the Obama transition team, the treatment advocacy organization Faces and Voices of Recovery, a stalwart in many drug policy reform efforts, supported the Ramstad nomination.

"Clearly, the appointment of a person in long-term recovery from addiction to this important position would inspire the millions of Americans and their families who have battled addictions," wrote the group's executive director, Pat Taylor. "Even if Congressman Ramstad were not in recovery, he would be an excellent candidate for the Director of ONDCP. A Member of Congress for 18 years, he is a highly experienced and respected legislator who led the successful battle to require health insurers to cover addiction treatment at parity with other medical conditions. He founded and co-chaired the bi-partisan Addiction Treatment and Recovery Caucus and the Law Enforcement Caucus on Capitol Hill and has been influential in shaping drug policy in countries around the globe. He was a practicing criminal justice attorney for five years and has served on numerous non-profit boards; all of whom have the reduction of the global demand for drugs as part of their mission."

And Ramstad has picked up support from progressive groups like his home state Wellstone Action, the legacy of progressive Minnesota Sen. Paul Wellstone. In a January 9 letter, the group argued that despite Ramstad's misguided stands on needle exchange and medical marijuana, he still deserved the nomination. "Congressman Ramstad's leadership on policies and programs within the White House Office of National Drug Control Policy will serve President-elect Obama's administration and millions of Americans well," Wellstone Action said.

The reform movement is split on Ramstad, with treatment advocates coming down in favor and harm reductionists and drug law reformers opposed. As addiction skeptic Dr. Stanton Peele noted in the Huffington Post Tuesday: "For Wellstone, the Kennedy's, and many other progressives, the idea of treating substance abusers as disease sufferers is tremendously appealing -- indeed, one thrust of the drug policy reform movement is to shift from incarcerating addicts to treating them! But, for reformers, courting treatment advocates has come a cropper as addiction-as-disease proponents back a man who stands against drug policy reform's basic value of finding new, pragmatic approaches to drugs in America."

The drug reform movement is broad and encompasses many diverse actors. Where they come down on the Ramstad issue reflect philosophical differences as well as institutional interests. Just because we're part of a broader movement doesn't mean we're always going to agree.

Permission to Reprint: This article is licensed under a modified Creative Commons Attribution license.
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Any group that supports Ramstad-oppsoed to medical marijuana and needle exchange- does not deserve to be called a "drug reformer". Opposition to needle exchange and medical marijuana is anti-science and just part of the status quo.

Where is Everybody?

The list of organizations posting their concerns and ideas at the "Your Seat at the Table" forum at the Transition Team's now fills more than 155 pages. Search for the words/phrases related to "addiction" or "substance abuse" or "recovery" and the result is zero. Zip.

Obama's silence on drug and addiction issues is deafening. But so is the advocacy effort. Why hasn't a single organization posted policy suggestions there? I have tried to post, but it's for organizations, not individuals.

I think whatever policies/representation we end up getting will be exactly what we deserve given the collective silence of those who care about these issues.

I have been wondering about

I have been wondering about the same thing myself and I've wriiten emails to various organizations asking this exact question. All were met with thundering silence. What is going on? We are completely missing the boat here.

I posted comments that I can't find...

I am the Andrew Tatarsky who organized the letter referred to above expressing serious concern about Ramstad as either head of ONDCP or SAMHSA and calling for leadership that appreciates science rather than ideology as the basis for drug and drug treatment policy in this country. I have posted several comments in several different places on and have not been able to find them.

However, there has been quite a bit of press, radio and blog coverage of the letter and I have heard from several sources that we are having a significant impact though I have not heard a word from the Obama Team. You can go to my blog at, (click on BLOG on the lower left of the home page) to see the letter, signatories and a smattering of the coverage and developments on this issue.

I also have posted a piece on my blog and I copy it below that was written by a colleague on why it is so important to have a recognized professional with a strong science background leading SAMHSA. I am in the process of soliciting support from leaders in our field to sign on to these principles and send this as an open letter to President-elect Obama and Senator Daschle as well. I welcome all suggestions, comments and other constructive dialogue on this most important issue.

Andrew Tatarsky, PhD, Founding member and past president of the Division on Addiction, New York State Psychological Association.
The Importance of Appointing a Nationally Recognized Professional with a Strong Science Background to be the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA)

Virtually every family in America is affected by mental illness or addiction. The cost in personal suffering and economic loss is staggering. Part of the tragedy of mental illness and addiction is that these diseases typically strike in late adolescence and early adulthood, between 18-25 years of age. By contrast, most major medical illnesses occur much later in life. The World Health Organization found that mental illness and addiction were the leading causes of disability among Americans ages 18-45, confirming that these diseases rob young Americans of their most productive years.

The last two decades have witnessed dramatic scientific advances in understanding mental illness and addiction which have led to the development of effective treatments and prevention programs. Unfortunately, unlike standard protocols for advances in other areas of medicine, these treatments are not reaching the vast majority of the public who need them. For example, the United States spends about $120 billion annually on behavioral health care. Yet, less than 25% of this care is evidence-based, with 75% of questionable value. The result of the mediocre quality of behavioral health care is that many Americans are suffering needlessly and some are dying because they are not receiving treatment has been shown to work.

What can be done to solve this problem? Most advocacy groups call for increased spending. While lack of resources is part of the problem, increasing funding alone will not solve the problem. Currently, Americans are not receiving adequate value for the $120 billion that are spent annually and much more could be accomplished using existing resources. This is the main conclusion of a landmark report on the state of behavioral healthcare issued by the Institute of Medicine of the National Academy of Science in 2006.

The federal government’s response to this situation has been woefully inadequate. The federal agency responsible for overseeing the quality of behavioral health care and prevention is the Substance Abuse and Mental Health Services Administration (SAMSHA). SAMSHA has a $3.3 billion budget. An OMB review of this agency rated the agency’s programs as largely ineffective; an assessment shared by most mental health and addiction experts. Many politicians including Congressman and Senators who sit on relevant oversight committees have never heard of SAMSHA, despite the fact that SAMSHA is on the same organizational level in the Public Health Service as CDC and FDA.

One major reason for SAMSHA’s obscurity and dysfunction has been the failure to appoint a person with significant scientific and professional expertise to the lead the agency. Past administrators have been drawn from the ranks of state government with experience in community action, but without recognized high level scientific mental health, addiction, and public health expertise. By contrast, the recent heads of FDA and CDC have been nationally prominent scientists with accompanying expertise and stature to effectively lead their agencies.

President elect Obama has a unique opportunity to improve the treatment and prevention of mental illness and addiction by breaking with the past tradition of placing a political appointee with regulatory and administrative experience as the Administrator of SAMSHA. Instead, the Obama transition team should seek a professional with a national reputation of excellence as a scientist and innovator in implementing science-based mental health and addiction programs and public health models in communities. This move would be consistent with President elect Obama’s approach to attract the highest caliber professionals into government, has the potential to improve the lives of many Americans, and would elicit uniform praise from advocates, the scientific community, and the press.

Behavioral health care means addiction and mental health services combined.


I have a name in mind. Dr Alex DeLuca, addicitionologist, extraordinaire! Google him!

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